Canthopexy is a minimally invasive cosmetic surgery used to lift, suspend, and tighten sagging or drooping lower eyelids to counter facial aging. The patient’s eye appears tired with the outer angle of the eye lowered, and with puffy bags under the eye. When the canthal tendon loosens due to age, previous eyelid surgery, sun damage, paralysis, and smoking, it can cause sagging or drooping eyelids. The skin’s collagen and elasticity are broken down, giving rise to an aged-looking skin around the eyes.

Preparation & Expectation Before Surgery

The doctor will ensure the patient is in good physical health and is a non-smoker. S/he will explain the procedure, risks, and benefits. The doctor performs an in-depth examination to ensure that a canthopexy is appropriate.

The doctor will also check for lower lid laxity by performing the distraction test. In this test, the doctor grasps and pulls the eyelid anteriorly. Eyelid distraction of more than 6mm to 8mm means that laxity is present. To identify poor lid tone, the doctor performs the snapback test by pulling the lower lid toward the inferior orbital rim before releasing it.

Types, Purpose & Procedure

Canthopexy has been modified from the traditional blepharoplasty procedure, whose only goal is to stabilize the lower eyelid. Canthopexy restores the eye's shape and improves tension in the lower eyelid. The advantage of canthopexy is that it preserves tissue with reinforcements made on the existing tendon without detaching it. With improved tension in the eye, the amount of fat requiring removal reduces, which prevents the development of lower eyelid hollowness.

Often, canthopexy is performed in combination with a light surgical muscle tightening procedure such as lower blepharoplasty to raise sunken eyelid tissue. This combination also helps to soften the cheek-eyelid border. It can accompany or be an alternative to blepharoplasty. Canthopexy is preferred over canthoplasty when eyelid laxity is less severe, or a patient experiences only slight drooping since it does not involve any cutting of the muscle. 

In an outpatient setting, the oculoplastic surgeon will administer local anesthesia with sedation or general anesthesia. S/he makes an incision on the eyelid’s outer corner. The incision can be made through the lower lid, upper lid, or via coronal type access. The surgeon meticulously places sutures to elevate, tighten, and stabilize the canthal tendon and orbicularis oculi muscle. S/he does not need to detach or reconstruct the tendon. Canthopexy helps to support the external eye corners and minimize eyelid malposition risk following lower eyelid surgery. The oculoplastic surgeon then closes the incision.

Risks, Side Effects & Complications

Canthopexy is a standard and safe surgical procedure, and the risks are rare. The side effects are usually temporary and may include infection, poor healing of the wound, eye redness, bruising or swelling, and adverse anesthesia reactions.

Complications can arise if the surgeon tightens the lower lid excessively. If this happens, the lower lid margin follows the path of least resistance and goes down the globe instead of up. Undercorrection by the surgeon should also be avoided because the lids may still have excess skin, excess fat, and lid laxity, making the eyes to still appear tired.

After Care, Recovery & Outcome

Pain, localized swelling, eye redness, and bruising may last up to two weeks after surgery. The patient can use over-the-counter pain medications and cold compresses to relieve any pain and discomfort. Patients need at least two days to recuperate at home before they can return to work. However, patients must stay away from any strenuous exercise to enhance proper healing. To prolong the quality of canthopexy results, individuals are advised to protect the eye against the sun and to practise adequate skincare.

Canthopexy is non-invasive, therefore, recovery time is relatively short, unlike in other eyelid surgical procedures. Evidence of complete healing manifests several weeks after the procedure when the lower lids appear tightened and elevated. Individuals need to understand that canthopexy only slows down but does not stop the aging process. However, the effects of the surgery are long-lasting, especially when the individual lives a healthy lifestyle.

Canthopexy brings complete eye rejuvenation by restoring the tone and youthful contour of the aging eyelid. The procedure restores lower lid integrity  and subsequently, the globe is lifted back up. The eyelid angle is restored to its previous position. Only when the skin is excess is it considered for removal.

Because the tendon continues to age in a normal aging process, the patient may need to have a canthoplasty performed years later. Canthoplasty is a more invasive procedure that corrects a drooping and sagging lid, but focuses on the lateral canthus and surrounding supporting structures.